First episode psychosis (FEP) studies show that average time between onset of symptoms and first effective treatment is often one year or more1. This long duration of untreated psychosis (DUP) is undesirable for various reasons:

1. • Early treatment helps minimise the risk of serious consequences 2,3

2. • Shorter DUP is associated with better clinical response.4

3. • Early results suggest that early intervention in psychosis (EIP) service is more cost effective than generic services.5

The attitude to treatment of ‘Psychosis’ has recently changed from focusing on severe and enduring mental illness to include early intervention.10 New terms appeared including duration of untreated psychosis (DUP) from onset of positive psychotic symptoms until starting treatment and duration of untreated illness (DUI) from onset of prodrome until starting treatment.11

To access the local Primary Care experience of FEP before developing the local EIP service.

A confidential questionnaire consisted of 8 questions sent by the Clinical Governance Support Team (CGST) to all Northamptonshire GPs requesting response within 3 weeks.

Response rate is 43% (123 GPs responded out of 284). GPs are less likely to start treatment of FEP. FEP are less likely to ask for a psychiatric referral but more likely to accept if offered by GP. 53% of GPs tend to refer all FEP cases to psychiatric service & 43% only refer those who request/accept referral. 74% of GPs agreed that EIP service was needed, 21% were unsure The likely causes of delayed referral of FEP by GPs: Patients disengaging, stigma, difficulty accessing psychiatric service, carers’ lack of knowledge and diagnostic uncertainty.

FEP patients are less likely to ask for referral to psychiatric service but likely to accept if offered. The likely causes for FEP delayed referral to psychiatric service: patients disengaging, stigma, carers’ lack of knowledge, service is difficult to access or inappropriate and diagnostic uncertainty. GPs need to be adequately informed about EIP & their important role to achieve this.

Long-term memory is normally assessed with traditional measures such as the Wechsler memory scale. However, these measures might not fully capture individuals’ daily experiences. Long-term memory system has three separate information components: 1) encoding; 2) storage; and 3)retrieval. These three processes are thought to occur in the hippocampal formation. One of the main functions of the hippocampus is to construct and maintain spatial maps of the environment. In fact, when the hippocampus is selectively lesioned, humans present severe spatial memory deficits. The right hippocampus is involved in allocentric object location memory (objects that are part of the environment) and finding one's way through complex environments. This part of the hippocampus is activated during physical navigation. The left hippocampus is activated during the retrieval of memory of navigation. It seems that the visuospatial model requires the encoding, binding and retrieval of an event and its context. Given these findings, visuospatial navigation tasks likely explore long-term memory. In fact, visuospatial navigation can be considered as a valid surrogate for long-term memory and a good probe to activate the hippocampal formation. Neuroimaging studies have greatly improved the literature by providing confirmatory evidence that the hippocampus, together with the parahippocampal and posterior parietal cortices, are engaged in visuospatial navigation. Further, there is evidence from neuroimaging studies that the hippocampus is involved during complex navigational situations. The usefulness of visuospatial navigation as a measure of long-term memory will be discussed.

Croatian Young Psychiatrists and Psychiatric Trainees Section was founded on December 15, 2005. as part of Croatian Psychiatric Association, established to promote different activities using network of young psychiatrists accros the world. In order to indicate activities that could fulfill possible gaps in our educational system, we performed a study among psychiatry residents and young specialists from different Croatian psychiatric centers.

91 participants answered the questionnaire constructed to obtain information about profile of young psychiatrist in Croatia, objective parameters of educational quality to produce competent psychiatrist, evaluation of residency training and suggestions of how to improve the current educational system.

Study results indicate that Croatian psychiatry residents are derived from a pool of average to above average medical students and majority is engaged in postgraduate studies and research acitivities and shows high interest in specific psychiatric fields such as psychotherapy and clinical psychiatry, but low interest in community psychiatry and mental health. Most of participants are only partially satisfied with the current residency training and feel that most problems reside from the lack of practical psychotherapy, the inefficiency of the mentorship system and the lack of opportunities for student's exchanges with other countries.

The results of this study revealed the major problems of psychiatry residents in Croatia. Following those results, we will perform the study that would include mentors and supervizors from different Croatian psychiatric centers. That could enable the developement of specific interventions with aim to improve current residency training in Croatia.

Several genome-wide linkage scans have reported that chromosome 22q11-13 might contain susceptibility loci for both schizophrenia and mood disorder.

We genotyped 44 Chinese Han family trios with mixed family history of schizophrenia and mood disorder with 11 DNA microsatellite markers on chromosome 22q11-13. These markers spanned 56.55 cM on 22q11-13 with mean intervals of 5.66 cM and average heterozygosity 0.71.The transmission disequilibrium test (TDT) was used to search for susceptibility loci to schizophrenia and mood disorder.

Including all family trios regardless of proband diagnosis, we found six markers associated with susceptibility to psychotic disorders., including D22S420 (χ2=4.76, df=1, P=0.029)%3001D22S277 (χ2=5.44, df=1, P=0.020)%3001D22s315 (allele 5, χ2=7.00, df=1, P=0.008; allele 7, χ2=-4.83, df=1, P=0.028; allele 11, χ2=4.00, df=1, P=0.046)%3001D22S274 (allele 7, χ2=-5.40, df=1, P=0.020; allele 10, χ2=6.23 df=1, P=0.013)%3001D22S1160 (χ2=-4, df=1, P=0.046) and D22S1161 (χ2=5.14, df=1, P=0.023). When grouped separately into schizophrenia and mood disorder according to proband diagnosis, four markers D22S420(χ2=7.36, df=1, P=0.007) %3001D22S315 (allele 5, χ2=4., df=1, P=0.046; allele 7, χ2=-8.89, df=1, P=0.003)%3001D22S1161(χ2=6.23, df=1, P=0.013) and D22S280 (χ2=4, df=1, P=0.046) were significantly associated with schizophrenia, but were not significantly associated with mood disorder, D22S274(allele 7, χ2=5., df=1, P=0.025; allele 10, χ2=6, df=1, P=0.014) were significantly associated with mood disorder only, and D22S277(χ2=4, df=1, P=0.046) was associated with both schizophrenia and mood disorder.

These results indicate that chromosome 22q11-13 contains the susceptibility loci to schizophrenia and mood disorder, and that overlapping regions may be shared by these disorders.

According to the recent literature, stigma connected to schizophrenia has a negative impact on the commencement, process and the outcome of the treatment. The aim of this study was to investigate the attitude of nurses from our local community towards schizophrenia.

This study engaged 166 nurses (8 male, 158 female) employed at the Clinical Hospital in Osijek and the Primary Medical Care in Osjecko-baranjska County. The subjects have filled out the Canadian Community Antistigma Questionnaire during 3 mental health lectures for nurses.

Out of total of 166 nurses, 74.7% (124) of them has heard something about schizophrenia in the last couple of months. 45.8% (76) of nurses was employed at the institution that treated patients with mental illness. 34.3% (57) of nurses personally knew someone who was diagnosed with schizophrenia or were treated for schizophrenia themselves. The results have shown an extensive knowledge of the facts related to schizophrenia among the nurses in our local community. It has also emerged that the attitude to the person with schizophrenia is more negative, and the level of stigma is higher as the higher emotional involvement is required.

Medical staff has a good level of knowledge about schizophrenia. Emotional acceptance of the person with schizophrenia is lower as the closer contact is required. Because the results show a certain degree of stigma to schizophrenia in the population of nurses in our local community, it would be necessary to develop specific anti-stigma programs for medical staff.

To evaluate the effects of integrated treatment for first-episode psychotic patients.

In a randomised clinical trial of 547 first-episode patients with schizophrenia spectrum disorders, effects of integrated treatment and standard treatment was compared. The integrated treatment lasted for two years and consisted of assertive community treatment with programmes for family-involvement and social skills training. Standard treatment offered contact with a community mental health centre. Patients were assessed at entry and after one, two and five years by investigators that were not involved in treatment.

At the one-year and two-year follow-up psychotic and negative symptoms changed in favour of integrated treatment. Patients in integrated treatment had significantly less co-morbid substance abuse, better adherence to treatment, and more satisfaction with treatment. Use of bed days was 22 percent less in integrated treatment than in standard treatment. Results of five-year follow-up will be presented.

Integrated treatment improved clinical outcome and adherence to treatment. The improvement in clinical outcome was consistent in the one-year and two-year follow-ups.

Follow-up studies of schizophrenia have reported divergent rates of outcomes. In addition to definition and measurement challenges, one reason for divergence may be due to sampling biases. Our aim was to report clinical and social outcomes of schizophrenia in the longitudinal, unselected, population-based Northern Finland 1966 Birth Cohort, and describe associated factors.

Subjects with DSM-III-R schizophrenia (N=109) were followed prospectively from mid-pregnancy up to age 35 years. Used outcome measures were positive and negative symptoms, global clinical impression, use of antipsychotics, psychiatric hospitalisations, social and occupational functioning. Several definitions of good and poor outcomes were explored, and predictors of outcomes were analysed.

In a subsample of 59 cases with complete information of outcomes, good clinical outcome varied from 10% to 59%, and good social outcome 15-46%, depending on definition of outcomes. Poor clinical outcome varied 41-77% and poor social 37-54%. Two subjects recovered fully using the most stringent definition of outcome. Lack of friends in childhood, father's high social class, lower school performance and earlier age of illness onset predicted poor outcomes. When the whole sample was considered, early infant development around the age of 1 year was associated with worse course of illness.

Outcomes were heterogeneous and relatively poor in this sample of relatively young schizophrenia subjects. The results were influenced by the definitions and measurements of outcomes. Persons having a sub-optimal developmental trajectory with poor social contacts, poor school performance, and early age of illness onset seem to have the worst outcome.

Subjects with family history of psychosis and with prodromal symptoms are at risk for schizophrenia. The aim was to study whether adolescents with familial risk have more commonly prodromal features.

Members (N= 9,215) of the Northern Finland 1986 Birth Cohort, an unselected general population cohort, were invited to participate in a field survey conducted during 2001-2002. At the ages of 15-16 years, the study included a 21-item PROD-screen questionnaire developed for screening prodromal psychotic symptoms with 12 specific questions for psychosis (Heinimaa et al. 2003). The scale measured symptoms for last six months. The Finnish Hospital Discharge Register was used to find out parental psychoses during 1972-2000.

Of the males 24% and 37% of the females were screen positives for prodromal features at the age of 15-16 years. Of the offspring, 1.8% had parents with psychosis. The prevalence of screen positives was 26% in males and 36% in females with familial risk for psychosis.

Prodromal features of psychosis are prevalent in adolescence. It may be difficult to screen adolescent subjects at risk for developing schizophrenia with a questionnaire in a general population, especially as these symptoms do not appear to be more common among subjects with familial risk.

The Academy of Finland, the National Institute of Mental Health, the Signe and Ane Gyllenberg Foundation and the Thule Institute, Finland.

In this study, we want to evaluate the efficacy of a preventive weight management training. We hypothesize that this training will reduce weight gain, pathological metabolic parameters and will increase drug compliance and subjective well-being.

69 schizophrenic patients were included in this study, in all patients olanzapine was newly initiated. They were randomly assigned to verum and control group. Patients in the verum group attended the training every second week for 24 weeks. Physical and chemical parameters where measured regularly, and also eating behaviour, physical activity, quality of life, mental state and psychosocial adaptation.

28 patients dropped out during the first 4 weeks of intervention. The data of the remaining 41 patients (verum group N=21, control group N=20) was analysed. During the intervention there was no significant difference between the groups regarding weight-gain. Both groups gained weight slightly (verum group 3.02±4.06kg, control group 2.80±4.84kg). Concerning triglycerides we found an interaction effect of time and group (F(1)=6.697, p=.025), the same was found on the second scale of the questionnaire for eating behaviour (FEV), which measures to what degree eating behaviour is disturbed (F(1)=8,381, p=.013) and on the social functioning scale of the SF-36 (F(2,38)=3,34, p=.032). Regarding glucose tolerance challenge, there was a significant group effect at the first time of measure after intake of the glucose-dilution (F(1)=9.15, p=.016). Our results do not support the hypothesis that the intervention has the desired effects on body weight, but it influenced positively other metabolic parameters, eating behaviour and social functioning.

Auditory verbal hallucinations (AVHs) are among the most frequent and disabeling symptoms of schizophrenic diseases. In approximately one quarter of patients, AVHs have to be considered as therapy-refractory with regard to pharmacological treatment options. This group of patients may benefit from a treatment protocol with repetitive Transcranial magnetic stimulation (rTMS) aiming on an inhibition of AVH-associated increased activity of auditory brain areas in the temporal cortex. However, optimal protocols for the guidance and control of such innovative treatment regimens are still lacking.

We propose the application of a non-invasive optical imaging technique (functional Near-Infrared Spectroscopy; fNIRS) for the measurement of the AVH-related activity of the auditory cortex, for the guidance of the rTMS-treatment and for the control of a treatment success on the brain metabolic level.

In the reported patient, NIRS measurement indicated AVH-related activity in the left auditory cortex which strongly decreased after a period of three weeks with daily inhibitory rTMS treatment, in parallel with drastically diminished AVHs.

This is the first report of a NIRS-guided and –controlled inhibitory rTMS treatment of therapy-refractory AVHs in a schizophrenic patient. Given the excellent clinical applicability of the applied methods, the combination of fNIRS and rTMS might have the potential to establish new treatment options in psychiatry aiming on the modulation of pathological regional brain activity patterns.

Neuropsychological studies show the positive effect of treatment with atypical neuroleptics on cognitive functions in schizophrenia. The aim of this study was to assess the effect of olanzapine on prefrontal functions during 12-months of treatment in schizophrenia.

The study was performed in 48 schizophrenic patients, aged 20-48, who were treated with the generic olanzapine (Zolafren - Adamed, Poland). Psychometric evaluation was done using PANSS. Neuropsychological assessments included Wisconsin Card Sorting Test(WCST) and Trail Making Test and Stroop Color-Word Interference Test. The measurements were performed before, after 3,6 and 12 months of treatment. The daily dose of olanzapine was 5-25mg/day (mean 14.9 mg/day) after 3 month of treatment, and 5-20 mg (mean 13.6 mg/day), after 6 and 12 months of treatment.

The intensity of psychopathology on PANSS was at baseline 99 points, and after 3, 6 and 12 months of treatment 63, 54 and 51p, respectively, with significant systematic improvement during olanzapine treatment (p<0.001, ANOVA Friedman Test). After 3 month of treatment, there was a significant amelioration on TMT, Stroop, and WCST-conceptual responses. A after 3,6 and 12months of treatment significant improvements on TMT, Stroop and WCST were observed. The level of cognitive improvement was assessed with the decrease on negative symptoms. After 3 month – this correlated with improvement on TMT and WCST-perseverative errors, and after 6 and 12 months with TMT A and WCST perseverative errors.

The results obtained show a significant improvement of psychopathology and neuropsychological frontal lobe tests after long-term treatment with olanzapine.